Ford-Wyoming Application Form

APPLICATION FOR EMPLOYMENT
To The Applicant: We appreciate your interest in our Firm and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in seeking to place you in a position which, in our judgement, best meets your qualifications.

We are an equal opportunity employer and shall consider qualified applicants for all positions without regard to race, color, sex, religion, national origin, age, marital or even veteran status or the presence of a non-job related medical condition or handicap.
PERSONAL
Full Name*

PrefixFirst NameLast NameSuffix
Date of Application

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Are you 18 years or older?

YesNo
Are you a U.S citizen?

YesNo
If you are not a U.S citizen, do you have the legal right to remain permanently in the Unites States of America?

YesNo
Have you been previously employed here?

YesNo
If yes, date(s):
Supervisor's Name(s):
Have you filed an employment application here before?

YesNo
If yes, dates(s):
List any friends or relatives working here:
What method of transportation will you use to come to work?
EMPLOYMENT DESIRED
Position(s) applied for:
Kind of work being sought:

Full timePart timeOther
If part time, please specify hours and days desired:
Do you have any special training, skills, qualifications or other experiences that relate to the position(s) applied for?
Do you have any physical, medical or mental impairment or disability which would interfere with your ability to do the job for which you have applied for?

YesNo
If yes, please explain:
Salary desired:
Date available to start work:
EMPLOYMENT EXPERIENCE
1) Employer Name
Date(s) of Employment
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Work Performed
Supervisor
Reason for Leaving
2) Employer Name
Dates of Employment
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Work Performed
Supervisor
Reason for Leaving
3) Employer Name
Dates of Employment
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Work Performed
Supervisor
Reason for Leaving
EDUCATION
High School Name
Years Completed
Diploma

YesNo
College Name
Years Completed
Degree

YesNo
If yes, what were your courses of study?
Any Other Educational Training?
REFERENCES

(Do not include relatives or former employers)
1) Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Years Acquainted
2) Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Years Acquainted
3) Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Years Acquainted
MILITARY SERVICE RECORD
Have you had any experience in the Armed Forces of the United States of America or in a State National Guard?

YesNo
If yes, what branch?
Rank at discharge
Date of Discharge

MonthDayYear
Date
Are you in the reserves?

YesNo
If yes, date obligation ends

MonthDayYear
Date
Special/Technical Training
ADDITIONAL INFORMATION
Have you been convicted of a crime?

YesNo
If so, where, when and nature of offense:
Do you have a valid drivers license?

YesNo
State Issued
List professional, trade, business or civic activities and offices held, excluding groups the name or character of which indicate race, color, religion, sex, national origin, handicap, marital status or veterans status.
State any additional information that you feel may be helpful to us in considering your application.
Name and address of the person to be notified in the event of accident or emergency.
AUTHORIZATION AND UNDERSTANDING
Upon the signing of this application, I represent that all of the information now or hereafter given by me in support of my application for employment is true and complete. I authorize you to verify any of the information concerning my employment, education credit or medical history with the appropriate individuals, companies, institutions or agencies and I authorize them to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of such disclosure. I also authorize you to release any information regulated by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of such inquiries and disclosures. I agree that any false information in support of my application may subject me to discharge at any time during the period of my employment. If hired, I agree I will serve at the will of the firm and I agree that I shall be bound by rules, policies, regulations and terms and conditions of employment of the firm as they are from time-to-time changed with or without notice to me. I agree that either party may terminate the employment relationship, with or without cause, at any time for any reason. I hereby authorize the firm to deduct from each and every period of my pay any amounts necessary to offset any damages caused by me or the value of property or money entrusted to me. I fully understand that I am personally responsible for any entrusted to me and at my employer's discretion I may be prosecuted to the fullest extent of the law. I agree that these arrangements may only be altered in writing directed to me personally by the President of the firm. I further agree that if I should bring any action or claim arising out of my employment against the firm in which the firm prevails, I will pay to the firm any and all costs incurred by the firm in defense of said claims or actions, including attorney fees. I further agree that my employment is conditional until such time as the results of my pre-employment physical (if such physical is required) are known.
Signature

Clear
Date of Signature

MonthDayYear
Date
Should be Empty:

APPLICATION FOR EMPLOYMENT

PERSONAL

EMPLOYMENT DESIRED

EMPLOYMENT EXPERIENCE

EDUCATION

REFERENCES

MILITARY SERVICE RECORD

ADDITIONAL INFORMATION

AUTHORIZATION AND UNDERSTANDING